The study investigated the feasibility of including DPOAEs in the annual medical surveillance test battery for the identification of NIHL in a group of employees in a manufacturing industry in KwaZulu-Natal. Feasibility was investigated by exploring the sensitivity, specificity and predictive efficiency of DPOAEs, the ability of DPOAEs to detect subtle noise-induced cochlea changes, the test-retest reliability of DPOAEs and lastly, the duration of time taken to conduct the DPOAE test bilaterally. A cross-sectional and repeated measures within-in participant design was utilized in the study. A purposive convenience sampling technique was used, as well as a stratified sampling approach in order to realize objective two of the study. The study consisted of 60 participants, which were further stratified into four test groups, i.e. Group A: 0-3 years, Group B: 3.1-6 years and Group C: 6.1-9 years and Group D: 9.1-13 years of working within the beverage manufacturing industry. A high sensitivity and negative predictive value was reported in the current study, suggesting that DPOAEs may be able to identify those who present with subtle cochlea changes as a result of exposure to occupational noise. The sensitivity of DPOAEs was 100% at 1, 2, 4, 6 and 8kHz in the right ear and at 4 and 6kHz in the left ear. The specificity of DPOAEs in the current study ranged between 55%-97% across the frequency range in the right ear and 49%-88% in the left ear. A negative predictive value of 100% was obtained bilaterally across the frequency range, except at 8kHz in the left ear. Visual inspection of the DPgram in the current study revealed a bilateral reduction in DPOAE amplitudes for all test groups in the high frequency region of the DP-Gram, namely, 5477Hz and 7303Hz, in the absence of a statistically significant difference (p>0.05). A greater frequency range appears to be affected in this group of workers, indicating that the type of noise, namely, impulse noise, may result in cochlea changes. Corresponding changes on the pure tone audiogram were not observed, however, noise notch configurations were observed for the groups with a longer history of noise exposure. This was not seen bilaterally as is typically expected with NIHL. Good test-retest reliability across the frequency range obtained in the current study further indicates the feasibility of including DPOAEs in the annual medical surveillance test battery. Additionally, the current study calculated an average of 86 seconds (1 minute 26 seconds) to conduct the DPOAE test bilaterally, confirming that DPOAEs are a quick test to administer. The findings of this study suggest that DPOAEs may be used to monitor early subtle noise-induced cochlea changes for workers exposed to noise in the beverage manufacturing industry as part of the annual medical surveillance test battery. / Thesis (M.Comm.Path.)-University of KwaZulu-Natal, Westville, 2013.

Thesis (PhD)--Stellenbosch University, 2012. / Includes bibliography / ENGLISH ABSTRACT: Introduction: The increased prevalence of adolescent upper quadrant musculoskeletal pain (UQMP) is becoming a great concern to health professionals. The risk factors associated with adolescent UQMP are complex and multifactorial, including, among others sitting as a physical risk factor. However, no evidence exists to support sitting postural angles as a potential predictive factor for adolescent UQMP in computing high school students. Thus, the current project aimed to describe the three-dimensional (3D) sitting postural angles of computing South African high school students in a real-life setting, using a well-tested and documented posture measurement instrument. Methodology: This research project is comprised of seven related studies. Part I of the dissertation presents a systematic review describing the reliability and validity testing of posture measurement instruments. This is followed by three primary correlation and repeated measures observational studies aimed at ascertaining the reliability and validity of a newly developed 3D Posture Analysis Tool (3D-PAT) in the measurement of nine sitting postural angles of computing high school students. Part II of the dissertation presents a systematic review, that evaluates the latest published research evidence of whether sitting is related to UQMP, and, if so, to identify the elements of sitting that significantly contribute to UQMP. This review is followed by a description of a cohort study, with a prospective period of one year. The 3D-PAT was implemented in a clinical research setting in order to measure the 3D sitting posture of a cohort of asymptomatic computing high school students and in order to assess the outcome, seated-related UQMP, prospectively. The prospective study design enabled the research project to contribute to an understanding of any causative relationship between the exposure (sitting postural angles) and the outcome (seated-related UQMP) in a subgroup of adolescents (computer users). Results: After the first phase of psychometric testing of the 3D-PAT using high school students, the findings indicated that the instrument required modifications prior to further psychometric testing. The second phase of testing revealed that the 3D-PAT compared very well with the reference standard for measurement of the X-, Y- and Z-coordinates of the reflective markers on a mannequin. The findings from the phase three study, again using high school students, indicated that the 3D-PAT compared very well with the reference standard and justified its use for the measurement of six sitting postural angles of the upper quadrant in computing high school students. For the cohort study, a 60% response rate for participation was achieved at baseline, with 98% of the students participating at six-month and 80% at one-year follow up. Of the students, 33.5% complained of seated-related UQMP during the follow-up period. Exposure to increased head flexion (>80°) (ρ=0.0001) and the combination of increased head flexion and decreased cranio-cervical angles (ρ=0.007) were significant predictors of seated-related UQMP for those computing high school students complaining of pain greater than the 90th percentile for such. Conclusion: The project described in the current dissertation is the first research project to assess sitting postural angles in asymptomatic high school students, while they worked on desktop computers in a school computer classroom and to assess UQMP prospectively. The research project reports a causal relationship between increased head flexion and seated-related UQMP as increased head flexion was found to be a predictor of seated-related UQMP developing within six to 12 months for computing high school students with a pain score equal or greater than the 90th percentile for pain. The research project emphasises that further research is warranted to investigate the causal pathway between sitting posture and adolescents’ UQMP. / AFRIKAANSE OPSOMMING: Inleiding: Die stygende voorkoms van boonste-kwadrant muskuloskeletale-pyn (BKMP) onder adolessente is besig om ’n groot bron van kommer vir professionele gesondheidswerkers te word. Die risiko-faktore waarmee adolessente BKMP gepaard gaan, is kompleks en multifaktories. Dit sluit onder andere sit as ’n fisiese risiko-faktor in. Daar is egter nog geen bewyse om sittende posturale hoeke as potensiële voorspeller van adolessente BKMP te ondersteun nie. Dus beoog hierdie projek om die drie-dimensionele (3D) sittende posturale hoeke van Suid-Afrikaanse hoërskoolleerders wat ook rekenaargebruikers is, in ’n werklike omgewing te beskryf, deur gebruik te maak van ’n instrument wat postuur meet en wat goed getoets en gedokumenteerd is. Metodiek: Hierdie navorsingsprojek is saamgestel uit sewe studies. Gedeelte I van die proefskrif bied ’n sistematiese oorsig van betroubaarheids- en geldigheidstoetsing van instrumente wat postuur meet. Dit word gevolg deur drie primêre korrelasie studies en studies vir die waarneming van herhaalde meting wat die betroubaarheid en geldigheid van n nuut-ontwikkelde 3D instrument vir posturale analise (3D-PAT) bepaal, wanneer nege sittende posturale hoeke van hoërskoolleerders wat rekenaars gebruik, gemeet word. Gedeelte II van die proefskrif bied ’n sistematiese oorsig van die jongste gepubliseerde navorsing om te evalueer of daar bewyse is dat sit verband hou met BKMP, en, indien wel, om die elemente van sit wat betekenisvol bydra tot BKMP, te identifiseer. Die sistematiese oorsig word deur ’n beskrywing van ‘n jaarlange kohortstudie gevolg. Die 3D-PAT is gebruik in ’n kliniese-navorsingsraamwerk om die 3D-sitpostuur van ’n kohort simptoomvrye hoërskoolleerders wat rekenaargebruikers is, te meet en sitverwante BKMP as uitkoms in die vooruitsig te stel. Die studie ontwerp het dit vir die navorsingsprojek moontlik gemaak om ’n insiggewende bydrae te lewer tot begrip vir enige oorsaaklikheidsverwantskap tussen die blootstelling (sittende posturale hoeke) en die uitkoms (sitverwante BKMP) in ’n subgroup van adolessente (rekenaargebruikers). Resultate: Na afloop van die eerste psigometriese toesting van die 3D-PAT, waarin hoërskoolleerders gebruik is, het bevindings daarop gedui dat die instrument verander moet word voordat toetsing kan voortgaan. Die tweede fase van toetsing het getoon dat die 3D-PAT baie goed vergelyk met die verwysingstandaard vir die meet van die X-, Y- en Z-koördinate van die reflektiewe merkers op ’n mannekyn. Die bevindings van die derde fase van die studie, waartydens hoërskoolleerders weer gebruik is, het aangedui dat die 3D-PAT baie goed vergelyk met die verwysingstandaard. Dit het die gebruik van die instrument om ses sittende posturale hoeke van die boonste kwadrant van hoërskoolleerders wat rekenaars gebruik te meet, bevestig. Die kohortstudie het ’n 60%-reaksiesyfer vir deelname behaal tydens die basislynmetings, waarvan 98% leerders deelgeneem het aan die sesmaande-opvolgmetings en 80% aan die eenjaaropvolgmetings. ’n Totaal van 33.5% van die leerders het gekla van sitverwante BKMP gedurende die eenjaar opvolgperiode. Blootstelling aan ’n vergrootte kopfleksie-hoek (>80°) (ρ = 0.0001) en die kombinasie van ’n vergrootte kopfleksie- en verminderde kranio-servikale hoek (ρ = 0.007) was betekenisvolle voorspellers van sitverwante BKMP vir die hoërskoolleerders wat rekenaars gebruik en kla van groter pyn as die 90ste persentiel daarvan. Gevolgtrekking: Hierdie projek is die eerste navorsing wat sittende posturale hoeke van simptoomvrye hoërskoolleerders wat op tafelrekenaars in die skool se rekenaarklaskamer werk, meet en BKMP voorspel. Die navorsingsprojek rapporteer ‘n oorsaaklikheidsverwantskap tussen ‘n vergrootte kopfleksie-hoek en sitverwante BKMP omdat vergrootte kopfleksie ‘n voorspeller is van sitverwante BKMP wat binne ses tot 12 maande by hoërskoolleerders wat rekenaars gebruik, met ‘n pyntelling gelyk of groter as die 90ste persentiel van pyn, ontwikkel. Die navorsingsprojek beklemtoon dat verdere navorsing om die oorsaaklikheidsroete tussen sitpostuur en adolessente BKMP te ondersoek, geregverdig is. / Medical Research Council of South Africa / National Research Fund / Division of Research Development and Support of Stellenbosch University

Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Access to wheelchairs is considered a basic human right. Wheelchairs enhance function, improve independence, and enables persons with disabilities to successfully live in the community. An inappropriate wheelchair may however limit function rather than promote it. Achieving an ideal match between user and technology, however is challenging. A recent audit in the Eastern Cape revealed that standard folding frame type wheelchairs were predominantly being issued and waiting list for wheelchairs is long. The need for investigation into prescription practice, from the perspective of both prescribing therapists as well as wheelchair users, was identified. Aims: To describe wheelchair prescription practice in the public sector of the Eastern Cape; and to determine whether the wheelchairs being issued address the psychosocial needs of users. Study design: A descriptive mixed-method cross-sectional study design was used. Quantitative and qualitative data from questionnaires and functional wheelchair skills tests of wheelchair users (Phase 1) and from semi-structured interviews with prescribing therapists (Phase 2) was used to describe prescription practice and investigate the psychosocial needs of wheelchair users. Methods: A small sample of convenienve according to home address was obtained that included 30 users (15 from a rural; 15 from a semi-rural setting). The Psychosocial Impact of Assistive Devices Scale (PIADS) questionnaire, Functioning Everyday with a wheelchair (FEW/FMA) scale and a self-compiled wheelchair specifications checklist (WSC) were used to determine user functionality and level of satisfaction with the wheelchair. Purposive sampling was done to identify the therapists that had prescribed the wheelchairs for the participants in the first phase of the study. A semi- structured interview was used to determine prescription practice including perceived barriers of wheelchair prescription with ten prescribing therapists. Data analysis: Qualitative data was analysed deductively and frequency of responses tabulated. Quantitative data was summarised as means and standard deviations and subgroup analysis comparisons were done using the Chi-square test and relationships between variables investigated using Pearson/ Spearman correlation or ANOVA. A p < 0.05 was deemed significant. Results: Eighty three % of wheelchairs issued were urban wheelchairs. These are generally perceived by users as sufficient to address their psychosocial needs regarding mobility and transport, however, seem to fail users in terms of accessibility and independence within their rural/ semi- rural environment. According to the WSC scores, peri-urban wheelchairs were found to be more appropriate for the users than urban wheelchairs (p < 0.01). No significant relationships were found between wheelchair fit, use of a cushion, occurrence of pressure sores and self-perceived psychosocial needs in this sample. The users experienced most difficulty with outdoor mobility (57% needed full assistance) and transport (63% needed full assistance) within their current wheelchairs. Ten prescribing therapists participated in the study. Most valued appropriate seating, are knowledgeable regarding prescription practice, but reported several barriers to this practice including budget restraints (90%), time to delivery (100%) and lack of training (40%). The need for more appropriate wheelchair designs to suit multi- level manoeuvrability of persons in rural/ semi-rural environments was also reported (60%). Conclusion: The results of this study show that wheelchair prescription in the Western Region of the Eastern Cape (WRoEC) has various challenges. Although the wheelchair users were mostly satisfied with their wheelchairs, this study identified areas for improvement in the users’ functioning, postural support and biomechanics within their wheelchairs, especially as it relates to their home environment. There is scope for improvement of wheelchair delivery to persons in the WRoEC – from on-going training of therapists and clients to more appropriate wheelchair designs for persons in rural settings. Further research in this field is recommended. / AFRIKAANSE OPSOMMING: Agtergrond: Toegang tot rolstoele word as ‘n basiese mensereg geag. Rolstoele dra by tot verbeterde funksionaliteit, groter onafhanklikheid, en bemagtig mense met gestremdhede om suksesvol in die gemeenskap te lewe. Nietemin, ‘n onvanpaste rolstoel mag funksie beperk eerder as om dit te bevorder. Om die ideale pas tussen rolstoel gebruiker en tegnologie te vind is uitdagend.’n Onlangse oudit in die Oos- Kaap het getoon dat standaard vou-raam tipe rolstoele oorwegend uitgereik word, en dat die waglys vir rolstoele lank is. Die gaping vir verdere ondersoek rakende voorskrif praktyk, vanaf beide die perspektief van die terapeute wat voorskryf asook rolstoel gebruikers, is geidentifiseer. Doel: Om rolstoel voorskrif praktryk in die publieke sektor van die Oos- Kaap te beskryf; en om vas te stel of die rolstoele wat uitgereik word die psigososiale behoeftes van gebruikers addresseer. Studie Ontwerp: ‘n Beskrywende gemengde metode deursnee studie ontwerp is gebruik. Kwantitatiewe en kwalitatiewe data van vraelyste en funksionele rolstoelvaardigheids toetse van rosltoel gebruikers (Fase 1) en van semi- gestruktureerde onderhoude met voorskrywende terapeute (Fase 2) is gebruik om voorskrif praktyk te beskryf en om die psigososiale behoeftes van gebruikers te ondersoek. Metodes: Dertig rolstoel gebruikers (15 van ‘n landelike; 15 van ‘n gedeeltelik- landelike opset) het deelgeneem in die studie. Die PIADS vraelys, “Functioning Everyday with a Wheelchair” (FMA/ FEW) skaal en ‘n self-opgestelde rolstoel spesifikasie kontrolelys (WSC) is gebruik om gebruiker funksionaliteit en tevredenheid met die rolstoel vas te stel. ‘n Semi- gestruktureerde onderhoud is gebruik om rolstoel voorskrifpraktyk insluitend persepsies van beperkinge tot die voorskrifte van rolstoele vas te stel onder tien terapeute. Dataverwerking: Kwalitatiewe data is deduktief geanaliseer en getal response is getabuleer. Kwantitatiewe data is opgesom as gemiddeldes en standaardafwykings en subgroep analise vergelyking is gedoen deur middel van die Chi- square toets. Verhoudings tussen veranderlikes is ondersoek deur middel van die Pearson/ Spearman korrelasie/ ANOVA. P < 0.05 is as statisties beduidend aanskou. Resultate: Drie-en-tagtig % van die uitgereikte rolstoele was landelike rolstoele. Hierdie stoele word oor die algemeen deur gebruikers ervaar as genoegsaam om hulle psigososiale behoeftes rakende vervoer en mobilitiet te bevredig, maar skiet nietemin tekort as dit kom by toeganklikheid en onafhanklikheid binne hulle landelike-/ semi- landelike omgewing. Volgens die WSC resultate, is die semi- landelike rolstoele meer toepaslik vir die gebruikers as die stedelike rolstoele. Geen merkwaardige verhoudings is gevind tussen rolstoel pas, gebruik van kussing, druksere en persepsie van psigososiale behoeftes nie. Die gebruikers het die meeste gesukkel met buitemuurse mobiliteit (57% het volle bystand benodig) en vervoer (63% het volle bystand benodig) in hulle huidige rolstoele. Tien terapeute het aan semi-gestruktureerde onderhoude deelgeneem. Daar is bevind dat hulle korrekte “seating” waardevol ag, kundig is rakende voorskrif praktyk, maar het talle beperkinge geidentifiseer in die praktyk insluitend: begrotings beperkings (90%), tyd tot aflewering (100%) en tekort aan opleiding in dié veld (40%). Die behoefte aan meer toepaslike rolstoel ontwerpe om multi- dimensionele beweeglikheid van persone in landelike/ semi- landelike omgewings te verseker, is ook vasgestel (60%). Gevolgtrekking: Die resultate van hierdie studie toon dat die voorskryf van rolstoele in die Westelike streek van die Oos- Kaap (WSvOK) vele uitdagings het. Alhoewel die rolstoel gebruikers grotendeels tevrede was met hulle rolstoele, het hierdie studie areas vir verbetering geidentifiseer in die gebruikers se funksionaliteit, posturale ondersteuning en biomeganika in hulle rolstoele, veral soos dit van toepassing is op hulle tuis omgewing. Daar is ruimte vir verbetering vir rolstoel lewering aan persone in die WSvOK; vanaf deurlopende opleiding vir terapeute en gebruikers, tot meer toepaslike rolstoel ontwerpe vir persone in landelike gebiede. Verdere navorsing in dié veld word aanbeveel.